Healthcare Provider Details

I. General information

NPI: 1487106464
Provider Name (Legal Business Name): JEAN HUANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17290 JASMINE ST
VICTORVILLE CA
92395-7709
US

IV. Provider business mailing address

309 W BEVERLY BLVD
MONTEBELLO CA
90640-4308
US

V. Phone/Fax

Practice location:
  • Phone: 760-951-2400
  • Fax:
Mailing address:
  • Phone: 323-725-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number655432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: